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Hampshire CAMHS School Info

Please complete this form to the best of your knowledge.

Please complete every section; the form cannot be completed if any section is left unanswered.

This form must be completed in one go.

If you are finding it difficult to complete this form for any reason, please call us so that we may help you.

Hampshire CAMHS School Info


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Important Information

This service if for patients who are aged over 5 and under 19

Other Professionals and Services

What other professionals/services have been or are currently involved with the child:

SENCo*

Primary Behaviour Service*

Children's Services*

Early Help Hub*

Educational Psychologist*

EWO, ELSA or Key Worker/LSA Psychologist*

Are you are aware of any other professionals/agencies involved with the family? *

Attendance at School/College

How would you describe the young person's attendance at school/college? *

Is the young person on the SEN register/ has an EHCP in place or do they have an individual education plan? *

Do you know if the YP has any additional needs other than learning needs?

With their attention and concentration?*

With their levels of hyperactivity?*

With their levels of impulsivity?*

Did you have to accommodate the classroom to meet these needs?*

What are the young person's attainments? *

Have you screened for/considered a specific learning difficulty?*

Does the young person appear tired in school?*

Are you aware of any significant life changes for this young person (e.g. bereavement, family break-up or reconstitution, illness within family including mental health difficulties)?*

Other health concerns

Do you have any concerns regarding your child / young person's?

General Health*

Vision*

Hearing*

Fine Motor Skills (e.g. writing)*

Gross Motor Skills (e.g. balance, running, carrying)*

Learning Difficulties (e.g. dyslexia)*

Brain Injury*

Sensory Hypersensitivity (e.g. texture, smells, sounds, etc)*

Seizures*

Other (physical or mental health)*

SNAP-IV Questionnaire

  • For each item, select the box that best describes this child / young person
  • There will be space at the end of the form for extra information you may wish to provide.
  • Please also send copies of any reports you may already have for this young person, such as an EHCP or Speech and Language reports to

Attention Levels

Activity

Impulsivity

Other Information

Terms & Conditions

The information you have provided will only be used for the purpose of undertaking an ADHD assessment and contacting you about this assessment. Your information will not be shared with anyone else without your consent. Information will be held as a part of the service user's record in line with the NHS Records Management Code of Practice. For more information on how we use your information, please see our privacy policy.